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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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  Editorial …

13th July 2011, Wednesday

Banned drugs still available: whom to blame?

Yesterday I was called by AajTak News to comment on the continuing availability of three banned drugs Gatifloxacin, Tegaserod and Rosiglitazone in the markets in India.

The response of the chemist to this issue was that once a drug has been banned it’s the duty of the pharmaceutical company to immediately recall its stocks. If they do not do so and the doctors keep on prescribing the said drug then how could they not dispense it.

When we talked to many doctors they said they have no means to know when a drug has been banned or a new drug is introduced in the market. The pharma representatives come and inform whenever a new drug has been introduced but not when a drug is banned.

The banned drug list on the website of DCI has not updated since 2008. New drugs introduced list is updated only twice a year. Banned drugs circulars are only for a brief period. If a drug is banned, it becomes the duty of the DCI to inform all registered doctors within a week. MCI and the State Medical Councils have the list, then what is the difficulty in communication.

Gatifloxacin was banned in March 2011. As per the circular, Gatifloxacin ban was for manufacture, sale and distribution of Gatifloxacin formulation for systemic use in human by any route including oral and injectable.

Its surprising that after Gatifloxacin was banned its ophthalmic formulation was approved. As per the DCI site, on 19.5.11, Gatifloxacin 0.3% + Loteprednol Etabonate 0.5% + Benzalkonium Chloride 0.01% w/v Ophthalmic suspension was approved for post operative steroid repulsive inflammatory ocular conditions when ocular bacterial infections or a risk of bacterial infection exists. Such discrepancy is sufficient to confuse the treating doctors.

Following are the drugs that have been recently banned.

  1. Gatifloxacin, Tegaserod were withdrawn from the market on 16th March 2011.
  2. Rosiglitazone, the diabetic drug was banned on October 7 2010 with immediate effect.
  3. Following drugs were banned on 10th Feb 2011
    a. Nimesulide formulations for human use in children below 12 years of age
    b. Cisapride and its formulations for human use.
    c. Phenylpropanolamine and its formulations for human use.
    d. Human placental extract and its formulations for human use.
    e. Sibutramine and its formulations for human use.
    f. R–Sibutramine and its formulations for human use.

When ever a drug is banned its the duty of the state drug controller to ensure that the ban is immediately effective and the formulations called from the market on top priority. The chemists and druggists are directed to stop the sale of these drugs and return the unused stocks to the manufacturers.


  1. The DCI site is http://www.cdsco.nic.in/
  2. The section Drugs Banned in India http://cdsco.nic.in/html/Drugsbanned.html mentions since 2003 only about the following drugs
    a. Fixed–dose combination of Cyproheptadine with Lysine or Peptone banned on Jan 1, 2003 vide GSR 170(E) dated dt.12.3.01
    b. Astemizole banned on Apr.1, 2003 vide GSR 191(E) dt.5.3.03
    c. Terfinadine banned on Apr.1, 2003 vide GSR 191(E) dt.5.3.03
    d. Phenformin banned on Oct.1, 2003 vide GSR 780(E) dt.1.10.03
    e. Rofecoxib banned on Dec 13, 2004 vide GSR 810(E) dt. 13.12.04
    f. Valdecoxib and its formulations banned on July 25, 2005 vide GSR 510(E) dt. 25.07.05
    g. Diclofenac and its formulations for animal use banned on July 4, 2008 vide GSR 499(E) dt.4.07.08

No drug has been added to the list after 2008. The list needs to be updates every week if not every day. If a drug is banned and is still available, the license of the pharma company should be cancelled.

Dr K K Aggarwal
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    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Banned drugs still available: whom to blame?

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Nationsl Conference on Insight on
Medico Legal Issue

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal welcomed all the delegates in the recently concluded Nationsl Conference on Insight on
Medico Legal Issue

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time a conference was posted live on Facebook & Twitter


Following are the Posts

  • Keynote address by Justice A.K. Sikri, Hon’ble Judge Delhi High Court
  • Dr. H.S. Risam addressed the gathering
  • Dr. A.K. Aggarwal, President Delhi Medical Council welcomed the guests

The inaugural lamp was lit by Hon’ble Mr Justice AK Sikri, Judge Delhi High Court; Hon’ble Justice Vipin Sanghi, Judge Delhi High Court; Dr HS Rissam, Member Board of Directors MCI: Dr Ranjit Roy Chaudhury, Past President DMC, MCI; Dr AK Agarwal, President DMC. Dr Girish Tyagi, Registrar DM: Dr Vinod Khetarpal, President DMA: Dr P K Dave, Former Director, AIIMS and Dr Sanjiv Malik, Past National President, IMA, Dr Ashok Seth and Dr Prem Kakkar were also the part of inaugural ceremony.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Dr Monica and Brahm Vasudev)

New CDC advice on postpartum contraception

The CDC has recommended further restrictions on the use of combined hormonal contraceptives –– those that contain both estrogen and progestin –– in the postpartum period among women who are not breast feeding.

Recommendations published last year had advised that combined hormonal contraceptives should not be used in the first three weeks after delivery, with no restrictions after that, according to Naomi Tepper, MD, of the CDC’s Division of Reproductive Health in Atlanta, and colleagues.

The restriction was put in place because combined hormonal contraceptives carry a slightly elevated risk of venous thromboembolism in healthy women of reproductive age, which could compound the higher risk of venous thromboembolism that occurs during a normal pregnancy due to hematologic changes.

After an evidence review, however, the CDC placed a further restriction –– reported in the July 8 issue of Morbidity and Mortality Weekly Report –– on the use of combined hormonal contraceptives from 21 to 42 days postpartum among women with risk factors for venous thromboembolism.

Those risk factors include an age of 35 and older, previous venous thromboembolism, thrombophilia, immobility, transfusion at delivery, obesity, postpartum hemorrhage, preeclampsia, smoking, or a recent cesarean delivery.

Women without such risk factors generally can start taking combined hormonal contraceptives three weeks after giving birth, according to the updated guidance. (Source: Medspage Today)

Diabetes: Sweet Disaster

The Impaired Glucose Tolerance (IGT) test or in layman’s term the pre–diabetic test is an effective early warning Nilakshi Sharma

Asilent, sweet epidemic is underway the world around. Diabetes, literally a sweet disease is slowly but surely spreading around the world. From an estimated 30 million diabetics in 1985, there were nearly 135 million diabetics in the world just a decade later. According to the World Health Organisation estimate in 2000 the number was 171 million affected and it is estimated that by 2030 at least 366 million people worldwide will be diabetics. (Source:TOI, Kolkata edition July 9, 2011)

    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Innovative running clinic to reduce injuries, improve times

Loyola University Health System is launching an innovative new Running Clinic that will help runners avoid injury, improve their stride and boost race times. more.......

    Twitter of the Day

@DrKKAggarwal: #AJD Diabetes mellitus (DM) is a metabolic dysfunction syndrome characterized by chronic hyperglycemia,… http://fb.me/1ahIFdzzN

@DeepakChopra: #cwellbeing What is the one thing you can do today to improve your social well being? Please state your country when responding #cwellbeing

    Spiritual Update

Science behind Hanuman Chalisa

Nava Nidhi

Surya Vigyan: This solar science is one of the most significant sciences of ancient India. This science has been known only to the Indian Yogis; using it, one substance can be transformed into another through the medium of sun rays.

    An Inspirational Story

Life Is A Gift

Today before you think of saying an unkind word–think of someone who cant speak. Before you complain about the taste of your food–think of someone who has nothing to eat. more.....

    Pediatric Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

What is Bronchiolitis?

A1. Bronchiolitis is a clinical syndrome characterized by the acute onset of respiratory symptoms in a child younger than 2 years of age. more....

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  Did You Know

(Dr Uday Kakroo)

The Swine Flu vaccine in 1976 caused more death and illness than the disease it was intended to prevent

  Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)


The test measures the level of this peptide in the blood. It is generally found in amounts similar to insulin due to the fact that insulin and C–peptide are linked when first made by the pancreas. Insulin helps the body control the amount of glucose in the blood. Insulin allows glucose to enter body cells where it is used for obtaining energy. Level of C–peptide in the blood can show how much insulin is being made by the pancreas. C–peptide does not affect the blood sugar level in the body.

  • High levels of both C–peptide and blood glucose are found with type 2 diabetes or insulin resistance (such as from Cushing’s syndrome).
  • High levels of C–peptide with a low blood glucose level may mean an insulin–producing tumor of the pancreas (insulinoma) is present or the use of certain medicines such as sulfonylureas or meglitinides.
  • If C–peptide levels are high after an insulinoma is taken out, it may mean that the tumor has returned or that the tumor has spread to other parts of the body.


  • Low levels of both C–peptide and blood glucose are found in liver disease, Addison’s disease, or insulin therapy.
  • Low level of C–peptide with a high blood glucose level is found in people with type 1 diabetes.
  • Complete removal of the pancreas (pancreatectomy) causes a C–peptide level very low.
  Contrary Proverbs

(Mr Vipin Sanghi)

Great starts make great finishes. BUT It ain’t over ‘till it’s over.

    Legal Question of the Day

(Dr MC Gupta, Advocate)

What can be done if the CEA authorities allow quackery?

QUESTION—How will the CEA help to curb quackery if the CMO and the DM, being the District Authority under the Act, do not take necessary action?

What can be done against them?


  1. No authority is above law. Even the PM can be hauled up in the court under the PCA (Prevention of corruption) Act.
  2. If the District Authority does not act, it can be made to act by the following devices:
    a—By filing an application under the RTI Act.
    b—By filing an appeal to the State Authority.
    c—By filing a writ petition.

However, no individual doctor should have to do that. This should be done by the IMA.

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    IJCP Special

Dr Good Dr Bad

Situation: An elderly male with FUO had high ESR.

Make Sure

Situation: A terminally ill patient who develops bed sores, is prescribed only systemic antibiotics.

  SMS of the Day

(Dr GM Singh)

A journey of a thousand miles must begin with a single step. ~ Lao Tsu

  GP Pearls

(Dr Pawan Gupta)

Mild persistent asthma:– Add low dose inhaled corticosteorides.

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Scuffle, injury and heart failure

Infliction of an injury blunt or sharp on human body may precipitate a myocardial infract or arrhythmia.

  • The emotional upset produced due to injury, or even the threat of fear of an injury can cause death due to transient hypertension or tachycardia that may precipitate arrhythmia, cerebral or sub-arachnoids bleeding resulting into death.
  • It has been also seen during post mortem examination that physical effort that damaged a diseased heart when the deceased was performing an unaccustomed work to accidents or other trauma and to the extra physical demands while working with a defective equipment.
  • A heart attack may occur while a scuffle and fight. The person may sustain simple injury and injury not sufficient to cause death in ordinary course of nature, and the person died due to heart failure.
  • This happen due to unusual physical or mental strain precipitating coronary insufficiency.
    Mind Teaser

Read this…………………

In which of the following diseases, the overall survival is increased by screening procedure?

1 Prostate cancer.
2 Lung cancer.
3 Colon cancer.
4 Ovarian cancer.

Yesterday’s Mind Teaser:
Which one of the following soft tissue sarcomas frequently metastasizes to lymph nodes?

1. Fibrosarcoma.
2. Osteosarcoma.
3. Embryonal Rhabdomyosarcoma.
4. Alveolar soft part sarcoma.

Answer for yesterday’s Mind Teaser: 3. Embryonal Rhabdomyosarcoma.

Correct answers received from: Dr K Raju, Dr BB Aggarwal, Dr Jainendra Upadhyay, Dr U Gaur, Dr Anil Bairaria.

Answer for 11th July June Mind Teaser: Equal rights
Correct answers received from: Dr Rashmi Chhibber, Dr Rakesh Bhasin, Dr Vijay Kansal, Dr U Gaur,
Dr KV Sarma, Dr Anupam Sethi Malhotra, Dr Bina Sawhney.

Send your answer to ijcp12@gmail.com

    Medi Finance Update

(Dr GM Singh)

Nomination Facility

Nomination is a facility offered to investors to indicate the person to whom the investments can be transmitted on their death. The nominee alone can receive the proceeds of the investment irrespective of the existence of a valid will of the deceased. It enables easy transmission of investment which can otherwise be complicated by legal delays. If there is a dispute, the nominee holds the proceeds of the investment in trust till such time the legal heirs of the deceased investor are identified. A nominee has neither any right to the investment nor can they take any action related to the investment during the life–time of the investor.

    Laugh a While

(Dr. Anupam Sethi Malhotra)

Q. What can you never eat for breakfast?
A. Dinner.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name


DCI Approval Date

Pramipexole Di HCl monohydrate ER Tablet 0.375/0.75/1.5/3/4.5 mg

For the treatment of the sign and symptoms of idiopathic parkinsons disease


    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Free heart and obesity checkup camp on Sunday and Safety tips for monsoon season

A free heart and obesity checkup camp will be organized on Sunday July 17, 9am to 12 noon at Raghunath Mandir, Amar Colony, Lajpat Nagar IV, New Delhi. The checkup will include – ECG, Echocardiography, if required and other clinical parameters. The camp will be led by Padmashri & Dr. B.C. Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India.

Giving the details, Dr. Aggarwal said that increase in normal weight obesity is the new epidemic of the society. Any weight gain of more than 5 kg after the age of 20 is "normal weight obesity" unless proved otherwise. Normally one is not suppose to gain weight after the age of twenty.

Normal weight obesity is detected by increased abdominal circumference and presence of high triglycerides and low HDL good cholesterol in the blood, fatty liver in adults and ovarian cysts in girls.

Also any weight gain after the age of 50 is abnormal as during this period one starts losing weight.

Normal weight obesity is associated with increased incidences of high blood pressure, potbelly, diabetes and heart attacks.

People whose abdominal circumference is more than 80 cm could avail this free camp facility.

Forewarning the people regarding the monsoon season Dr Aggarwal said that going barefoot in this weather can be risky. Some who take off their shoes and socks suffer injuries such as cuts and puncture wounds. In some cases, those injuries develop infections that may require surgery.

There may be sharp objects under the water that cause injury

Safety tips

  • Get vaccinated against tetanus. Teens and adults should get booster shots every 10 years.
  • Wear sandals while walking in rains or around swimming pools. They’ll help protect against cuts and abrasions and prevent contact with viruses and bacteria that can cause athlete’s foot, plantar warts and other foot problems.
  • Many worm infestations may occur through the infected water.
  • Fungal infections of the foot are very common.
  • Diabetics should never go barefoot, even indoors, because they may not "feel" a foot injury.
  • If you suffer a puncture wound in the foot, see a doctor within 24 hours. A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications such as tissue and bone infections or damage to tendons or muscles in the foot.
  • Inspect the feet on a routine basis for skin problems such as warts, calluses, ingrown toenails, suspicious moles, spots or freckles. The sooner they are dsetected, the easier it is to treat.
  • Keep your feet dry always.
    Readers Responses
  1. Honorable Dr Aggarwal, I would be interested to know what could be the legal implications in case if the consultations are offered through email and a consultation fee is charged in lieu of that. Dr Sanjeev Rastogi, Associate Professor and Head Dept of Panch–Karma, State Ayurvedic College & Hospital, Lucknow University

    Responds: Its like any consult and one is liable for any error or negligence.
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.



Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011
(Screening of films October 14–17, Jury Screening at Jamia Hamdard University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi



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